The Carriers’ New Tool: Jacobi Medical Center

There are very few concepts under the New York Workers’ Compensation system that are in favor of the employer and carrier. Once a claim is established, employers and carriers have few tools on their side to even the playing field in the claimant-friendly world of workers’ compensation. In appropriate situations, for example, employers and carriers can litigate the issues of labor market attachment, fraud under WCL 114(a), and further causally
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Raising Self-Limitation on Reduced Earnings: A New Approach

How many times has your attorney heard this whispered after raising labor market attachment:  “Just go get any job out there and they’ll pay you the difference – any job will do.” If you work two hours a week, you’re attached and owed reduced earnings. This scenario came up during a recent litigation on the issue of labor market attachment and entitlement to awards. In that case, the claimant’s attorney
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Shifting Liability: A Lesson for General Contractors

Imagine this, you, a general contractor based in New Jersey, just secured a project from one of the biggest retailers to do some work at its warehouse in New York. Given the magnitude of the project, part of the work is subcontracted to another New Jersey company that guarantees it has workers’ compensation insurance. The project begins and you are unfamiliar with the number of subcontractor employees on-site, their day-to-day
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Proposed New York State Bill Proposes Sweeping Changes to NYS Workers’ Compensation System

Assemblyman Harry Bronson and State Senator Jessica Ramos have recently introduced Bill A7045 to the NYS Assembly and Senate that proposes sweeping changes to the NYS Workers’ Compensation System. As discussed below, if the bill were to be passed in its present form, it will have an impact on not only injured worker’s rights to potentially pursue a claim against their employer following a work-related injury, but also on how
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Do it Right or Pay the Price (of Medical Bills)

When an injured worker receives a medically necessary treatment, the employer or insurance carrier is responsible for payment of the treatment when the claim has been accepted or established. See NYCRR section 325-1.25. However, when the treatment is not medically necessary or under the Medical Treatment Guidelines, the carrier can object by filing the New York State Workers’ Compensation Board C-8.1 form (a copy should go to the WCB, the employee,
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One Missing IME, Too Many

I recently attended a hearing that was scheduled pursuant to claimant’s RFA-1, requesting reinstatement of awards. You’re probably wondering, why were awards suspended in the first place? Because claimant had missed three scheduled independent medical examinations (IMEs)! She also did not have current medical evidence of a further causally related disability at the last hearing. The prior notice of decision read wonderfully, “suspension is effective until such time that the
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Combating Injured Workers’ IME Reports

Employers, carriers, and third-party administrators are all too familiar with Section 137 of the New York Workers’ Compensation Law and 12 NYCRR Section 300.2, as they govern Independent Medical Examinations (IMEs). Failure to meet or substantially comply with the necessary requirements of Section 137 puts you at risk of having your IME report precluded by a workers compensation law judge. The same holds true for injured workers when they are
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New York Workers’ Compensation Full Board Issues Decision Regarding WCL Section 15(3)(w) and the Classification Caps

The New York State Workers’ Compensation Board recently issued a decision in Matter of Jacobi Med. Ctr., No. 00825967, 2019 WL 645558 (N.Y. Work. Comp. Bd. Feb. 11, 2019) ruling that a claimant is only entitled to benefits for the duration of the capped period, regardless of surgeries subsequent to the time of classification. In this case, the claimant was classified pursuant to a February 8, 2012 decision at a
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How Does it Work? Incarceration and Workers’ Compensation Benefits

The incarceration of a claimant receiving workers’ compensation benefits can be used as a defense to payment of indemnity benefits based on two similar, but distinct, arguments. In general, where the carrier has been directed to pay workers compensation indemnity benefits by the New York Workers’ Compensation Board, the carrier may only suspend indemnity benefits unilaterally (without a new direction from the board) in certain circumstances. Per 12 NYCRR Section
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Symptom Magnification and Schedule Loss of Use

In New York, work-related injuries to an extremity, such as the hands, arms, legs, fingers or toes, often result in awards associated with a permanent impairment of said extremity. Under the Workers’ Compensation Law, an injured worker may be entitled to monetary benefits for such an impairment, which are referred to as awards for schedule loss of use. A claimant bears the initial burden of producing a medical opinion to
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